Non-bacterial infections in Asian patients treated with alemtuzumab: a retrospective study of the Asian Lymphoma Study Group

Abstract

This retrospective study concerns non-bacterial infections in Asian patients receiving alemtuzumab. The clinical data of 182 patients treated with alemtuzumab alone or alemtuzumab-containing chemotherapy between the years 2003 and 2009 was collected from six Asian countries. Alemtuzumab was used in the setting of frontline (n =48) or salvage (n =90) treatment, and as a part of the conditioning regimen for allogeneic stem cell transplant (n =44). Reactivation of cytomegalovirus (66/182) and varicella zoster virus (25/182), and fungal infection (31/182) including invasive pulmonary aspergillosis, were the most common infectious complications in this retrospective analysis. Thus, we recommend routine prophylaxis with valganciclovir and itraconazole, especially when alemtuzumab is used in the conditioning regimen for allogeneic stem cell transplant. Pneumocystis jirovecii pneumonia (PJP) was found in four patients (3%, 4/122) receiving alemtuzumab as conditioning for stem cell transplant or salvage treatment. Three cases of hepatitis B virus reactivation were found in antigen-negative patients, and 16 cases of tuberculosis were observed. Infection is the major complication of alemtuzumab therapy, and these infectious complications are potentially severe and life-threatening. Based on our retrospective analysis, we have constructed a guideline for antimicrobial prophylaxis in Asian patients receiving alemtuzumab therapy.

Keywords::

• Alemtuzumab
• infection
• prophylaxis

Acknowledgement

This study was supported by a grant from the IN-SUNG Foundation for Medical Research (CA98671).

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article at www.informahealthcare.com/lal.

Appendix

In addition to the authors, the following investigators participated in the Asian Lymphoma Study Group meeting. Ramathibodi hospital, Thailand – Suporn Chuncharunee; Siriraj Hospital, Thailand – Archrob Khuhapinant; Cipto Mangunkusump General Hospital, Indonesia – Ronald Hukom; Ampang Hospital, Malaysia – Chang Kian Meng, Suriar Jay; Sime Darby Medical Center, Malaysia – Soo Chin Ng; National Cancer Center, Singapore – Kevin Tay, Bin Tean The, Choon Kiat Ong, Miriam Tao, Richard Quek, Leonard Hwan Cheong Tan; Singapore General Hospital, Singapore – Daryl Tan, Ivy Sng, Soo Yong Tan; Gleneagles Medical Center, Singapore – Yew Oo Tan; National University Hospital, Singapore – Yen Lin Chee, Wee Joo Chng, Siok Bian Ng; Chonnam National University Hwasun Hospital, Korea – Duck Hwan Yang.